Jerel Eugene Deldotto, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301005951 Issued in MI

Practice address

36405 Harper Ave
Clinton Township, MI 48035-2957

Phone

(586) 791-6060

Fax

(586) 791-8211

NPI assigned

Apr 27, 2006

Last updated

Mar 15, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Douglas Shore & Sylvia Voelker PTRS

  • Psychologist
  • Clinton Township, MI
  • NPI 1023280542
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268611200000",
    "number": "1124085816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36405 HARPER AVE",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480352957",
            "telephone_number": "586-791-6060",
            "fax_number": "586-791-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36405 HARPER AVE",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480352957",
            "telephone_number": "586-791-6060",
            "fax_number": "586-791-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELDOTTO",
        "first_name": "JEREL",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2010-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301005951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "620005726",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crystal Marie Degrandchamp, MA, LLPC
• Jodi Lynne Dejaeghere
• Daniel Dekorse
• Carrie Dekoski
• Jennifer Delazzari, LLPC
• Sharna Deluca
• Alexis Demchyna
• David William Demello, D.O.
• Robert Edward Demercurio, D.O.
• Ashley Demonique

• Psychologist in Clinton Township, MI
• Providers in Clinton Township, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.